Thursday, December 01, 2011

Medicare to Cover Preventive Services for Obesity

Preventive services for obesity now will be included under Medicare and can be provided by primary care physicians or primary care practitioners only (nurse practitioners, clinical nurse specialists, or physician assistants) in primary care settings only.

Under the regulations, announced on Tuesday by the Centers for Medicare and Medicaid Services, physical therapists do not currently fit all the requirements to provide obesity intensive preventive therapies, which include:

Screening for obesity in adults (BMI measurement; BMI ≥ 30 kg/m2);

Dietary (nutritional) assessment; and

Intensive behavioral counseling and behavioral therapy through high-intensity interventions, including diet and exercise.

Additionally, any behavioral intensity therapy should meet the 5-A framework recommended by the US Preventive Services Task Force:

Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

Primary care physicians in non-primary care settings are not precluded from conducting an obesity screening, then referring the patient to a primary care setting for further obesity therapy to be conducted by the primary care physician or primary care practitioner.

APTA is gathering the necessary supportive data to demonstrate the value of physical therapy interventions in reducing obesity and to advocate for inclusion of physical therapists in obesity prevention.

Comments

I believe it is imperative that the APTA advocate for Physical Therapists to be able to consult and be paid for obesity prevention. No other previously listed discipline would be more qualified to instruct people with exercise and lifestyle changes. This is a battle we must win for our profession to continue to be profitable.

Posted by Ronald Masone
on 12/1/2011 3:21 PM

I agree if we are going to promote ourselves as an access point to healthcare through direct access we must push for these types of opportunities. It is time that we stop being passive in our efforts of progressing our scope. No group is just going to hand us what we want we need to be bold in stating what we want and why we are likely the most qualified group of providers for such interventions.

Posted by C
on 12/1/2011 6:51 PM

I agree with Ronald. And, I am still astounded that we are not recognized as the health profession that has the most expertise in helping people achieve healthy lifestyles! The extensive dietary changes can be taught by others but we are the ones who monitor for follow through and progress people through exercise programs and functional training as the obese person's body changes. I am flabbergasted at the level of ignorance about what we have to offer!

Posted by Joan-Alice Taylor -> BMY]=
on 12/1/2011 8:18 PM

As a long time health and fitness professional with a background as a personal trainer and a PTA, I have long felt that physical therapy has let the ball drop on this one. Hopefully it will now be seen as imperative to get involved as part of an obesity reduction team. We are the best qualified to advise the public on proper and safe exercise as part of their weight reduction program, especially since many patients have a multitude of diagnoses compounding their problem and making it difficult for them to exercise in a traditional gym or health club environment.

Posted by Carolyn Heather Senn, PYA
on 12/1/2011 8:40 PM

Physical Therapists need to be included in this program. Our profession is critical in obesity prevention.

Posted by Susan E. Solow, DPT
on 12/2/2011 11:04 AM

It amazes me that physical therapist are not qualified to conduct obesity intensive preventative treatment! Aren't the majority of our patients obese!!!!! Hello?! Anyone listening who are making these preposterous decisions. PT's ALREADY treat patients with obesity. We should be able to provide preventative measures while they are in our care!
Christopher Lovelace, MPT

Posted by Christopher Lovelace
on 12/2/2011 2:39 PM

How much did our legislatures get paid to make a stupid decision like this? Md's are not trained i exercise and have minimal nutritional background. They typically spend 10 minutes with a patient etc.

Posted by Jake Wear -> =GR\>G
on 12/2/2011 4:07 PM

With obesity and type II diabetes being at or near epidemic levels, a medically guided exercise program would appear to be more than logical and who better suited to provide these services than the musculoskeletal experts - physical therapists. In addition, one of the main reasons people struggle with adding exercise to their regimens to fight obesity is due to the stress and strain on the hip, knee, ankle and foot joints. Physical therapists need to be involved with reducing obesity and type II diabetes to improve health and wellness as well as reduce the financial burden these medical issues place on society.

Posted by Darren Beilstein
on 12/2/2011 5:03 PM

Another example of 'too little too late' in regards to APTA efforts on this issue. My view is that out professional association is 'asleep at the switch' regarding the therapy cap, reimbursement cuts, and now regulatory areas for potential physical therapy services.

Posted by Tom Brocato
on 12/3/2011 8:46 AM

Has nobody heard of Metabolic Syndrome? It is severely lacking in CE courses, is the ABSOLUTE basis of the nations health care crisis and the ultimate area of interventions the Physical Therapists are trained and qualified to deal with. Now the "experts" leave us out of obesity interventions????? Who are these "experts" that are legislating our health care regulations? Let's face it most PCPs, NPs and PAs just want to write a prescription, adding one more problem to the overall problem! If they are not loading ketones then exercise is the best way to control their BG, if they are they are not following their diet. Both of these issues can easily be identified by a PT, and addressed in the home setting, without the expenses of the office visit. For once PTs understand it is our JOB to keep our patients out of the high costs of the hospital, polypharmacy and orthopedic surgeons operating theaters.

Posted by Keith Crimmel -> =OR_?L
on 12/3/2011 9:24 AM

I do think this is a great move on Medicare's part. Focusing more on preventing diseases and costs incurred with obesity is moving in the right direction. As a medigap plan broker, I often see obesity play a role in what choices are available whenever I help clients look for lower priced medigap plans. There are several companies that offer plans with no height and weight requirement, but those premiums tend to generally be higher. Those plans using a more strick underwriting guidelines tend to have the cheapest premiums. Bear in mind, the government standardized these plans years in the past, so each plan must give the same benefits and pay claims the same. It's like buying cheerios at Walmart or your local grocery. In either case, it's the same box of Cheerios. Hope this can help. - Heather

Posted by heather
on 12/3/2011 9:52 AM

Agree! This is an area PTs need to be included in and we are more than qualified for all the reasons previously listed! Thank you to the APTA for advocating for us!

Posted by Stefanie Czosnyka, PT, DPT
on 12/3/2011 11:31 AM

Funny! I have had greater than 10 patients sent to me in the last couple months for obesity and "deconditioning". With the sole purpose to help the patient lose weight. If this is an issue for the PA's and nursing then why are they sending them to PT? Really, are we gonna sit back and allow another opportunity to go by. We are the EXPERTS in not only exercise but education. Work for our profession or it will be gone!

Posted by Chad Molen
on 12/3/2011 3:16 PM

I believe having the ability to bill Medicare for preventative services in general and particularly for obesity is a must and a critical step in lowering healthcare costs. We as a nation must spend more dollars on prevention, its the only long term solution to bringing down costs.

Posted by Ben Shato, PT, OCS
on 12/3/2011 3:38 PM

My Doctoral research concerned the effects of obesity on the on kinetic chain. We should be involved in both preventative care AND correcting the kinetic chain as an obese person reduces their BMI.
Barbara J Piper, PT, DPT

Posted by Barbara Piper, PT, DPT
on 12/4/2011 8:50 AM

It makes no sense that we are being excluded from addressing obesity in favor of primary care physicians. The 2008 systematic review by Fleming concludes that:
* lifestyle counseling interventions delivered by primary care providers in primary
care settings to patients at low risk are only marginally beneficial
• Resources in primary care better spent on patients at higher risk of cardiovascular
disease.
We need to place more professional advocacy emphasis on reducing access barriers to cost-effective physical therapists that are better prepared to actually impact obesity.
Reference: Fleming P, Godwin M. Lifestyle interventions in primary care: systematic review of
randomized controlled trials. Can Fam Physician. 2008 Dec;54(12):1706-13. Review.

Posted by Rick Wickstrom, PT, DPT, CPE, CDMS
on 12/4/2011 12:08 PM

I completely agree with Tom Brocato above. APTA what are you doing!! APTA needs to be more proactive.

Posted by Jerry Yarborough -> =LR[DG
on 12/5/2011 12:24 AM

PTs. SHOULD be the recognized experts in anything related to exercise, especially when comorbidities exist. However, PCPs think exercise for obesity means walking, simple as that. This is one contributor to why these patients "fail" exercise. The system failed them as much as they may have failed the exercise. If they were good at exercising we wouldn't have this situation. These changes allow for earlier treatment with medication, not true prevention. However, this is the way with them. They are concerned with payment for services not which services are best suited for the condition or disease.

Posted by Jamey Gordon, DPT, ATC, CSCS
on 12/5/2011 8:05 AM

It is interesting to note that for 2012, measure # 128 for BMI is one of the allowable PQRS measures for both PT and OT in their evaluation of the patient. Referral to a primary care physician or other sources if the BMI is abnormal is one of the options of this measure. It does show some recognition of our skills in this area, and perhaps some ability in the future to be paid for obesity related services.

Posted by Lynn Berry
on 12/5/2011 11:59 AM

One reason we were not considered was the lack of any comment by APTA or any physical therapists during 2 months of open comment with CMS. Around 200 comments were received from psychologists, dieticians, other professional organizations, surgeons, etc. I am guilty as well for the lack of comment. I am surprised, however, that APTA did not know of the open period and post a comment in support of our profession.

Posted by Eric Bradford PT, MBA, GCS
on 1/15/2012 3:46 AM

I'm a 62 woman who suffers hypothyroid. Due to surgery. I have suffered taking synthroid for 12 years. Just resently discovered I was allergic to it. I gained 35 lbs. plus fatigue and other problems. I believe my new medication is beginning to take hold. Less fatigue. I try to be more active. It seems to run in cycles. I believe I could greatly benifit from Medicare's obisity prevention program. If you would consider Useing me as an example of what your program can do. I promise I will work as hard as I can to help you prove what PT can do. At 47 I was SW Florida's president of the Jet Ski Assc. Living in N Va now 30 miles from Wash DC now. Please consider what I'm asking.